ABSTRACT
INTRODUCTION AND IMPORTANCE: Foreign body ingestion is frequent in younger children, with generally good outcome on conservative management. However, magnetic beads ingestion is an exceptional cause of intestinal perforation in the older children. CASE PRESENTATION: An 8-year-old boy presented with clinical signs of generalized acute peritonitis. Abdominal plain X-ray confirmed the foreign object in the digestive tract and oriented the etiology by highlighting several air-fluid levels, distended small bowel loops, pneumoperitoneum and the presence of a bilobed foreign body projected adjacent to the 5th lumbar vertebra. Open surgical exploration was performed and revealed a peritoneal fluid, 2 perforations in the small bowel and 2 adhered pieces of magnets. A 20 cm ileal resection, including the segment with the 2 perforations, was performed followed by a terminal ileostomy. The restoration of gastrointestinal continuity was performed 16 days later. After a follow-up of 2 years and 8 months, the patient was free of any symptom. CLINICAL DISCUSSION: In cases of acute peritonitis due to perforation, the general condition deteriorates progressively. Fever may be absent, as was the case with our patient. Abdominal pain is the predominant symptom, it is often accompanied by vomiting that can be alimentary, bilious, or even fecaloid and/or by cessation of bowel movements and/or gas. Abdominal rigidity is a major physical sign, sometimes replaced by generalized guarding. CONCLUSION: Ingestion of gastrointestinal foreign bodies is rare in older children, the presence of more than one magnet can lead to peritonitis due to intestinal perforation.
ABSTRACT
Urine protein electrophoresis is often required for diagnosis and monitoring of urological or renal diseases and lymphoid hemopathies. We here report an uncommon urine protein electrophoresis result. The test was performed using agarose gel electrophoresis and capillary electrophoresis. It was a monoclonal peak of unknown significance migrating with gammaglobulins. Scientific literature and the tests performed demonstrated that it was myoglobin. In fact, myoglobin (17 kDa) is freely filtered by the glomerulus and normally reabsorbed by the tubules. If tubule capacity for reabsorption is exceeded, its presence results in overcharging proteinuria. Myoglobinuria helped diagnose rhabdomyolysis in our patient. Thus, the analysis of unknown peaks, can provide information on symptoms but also underlying pathologies, which may be of clinical interest.
Subject(s)
Myoglobinuria , Electrophoresis, Agar Gel , Electrophoresis, Capillary , Humans , Myoglobinuria/urine , Proteinuria/diagnosis , Proteinuria/etiology , UrinalysisABSTRACT
BACKGROUND AND PURPOSE: The indication and benefit of plasma level of antiepileptic (AEDs) has been debating in the monitoring of people living with epilepsy and the epilepsy treatment gap has largely been documented in developed countries. This study was aimed to highlight the epilepsy treatment gap between rural and urban Mali. METHODS: We conducted a pilot study on AEDs treatment from September 2016 to May 2019. For 6 months, 120 children and young adults living with epilepsy (rural site, 90; urban site, 30) received phenobarbital, valproic acid and/or carbamazepine. At our rural study site, we determined the AED plasma levels, monitored the frequency, severity and the duration of seizure, and administered monthly the McGill quality of life questionnaire. At our urban study site, each patient underwent an electroencephalogram and brain computed tomography scan without close monitoring. RESULTS: At the rural study site, patients were mostly on monotherapy; AED levels at 1 month (M1) (n=90) and at 3 months (M3) (n=27) after inclusion were normal in 50% at M1 versus 55.6% at M3, low in 42.2% at M1 versus 33.3% at M3 and high in 7.8% at M1 versus 11.1% at M3. AED levels at M1 and at M3 were significantly different p<0.0001. By M3, seizures (n=90) were <1/month in 26.7%, and lasted less than 1 minute in 16.7%. After a yearlong follow up, all 90 patients reported a good or excellent quality of life. At our urban study site, patients (n=30) were on carbamazepine and valproid acid in 66.67% and monotherapy (carbamazepine) in 33.33%. By November 2018, only six out 30 patients (on bi-therapy) were still taking their medications. CONCLUSIONS: Epilepsy diagnostic and treatment are a real concern in Mali. Our data showed appropriate AED treatment with close follow up resulted in a better quality of life of patients in rural Mali. We will promote the approach of personalized medicine in AED treatment in Mali.
ABSTRACT
Serum protein electrophoresis is of certain diagnostic interest. We report a case of unusual electrophoresis associated with cholestatic jaundice complicating a cholangiocarcinoma. The study involved a 55-year old patient hospitalized for the exploration of cholestatic jaundice. Capillary electrophoresis showed bisalbuminemia diagnosed based on the thickening of the bottom of the albumin peak and a supernumerary peak X. Second electrophoresis with Hydragel showed the disappearance of the two above abnormalities which was the proof that bisalbuminemia was acquired and of the lipidic nature of the Pic X. In our case, the most likely cause was the presence of interfering substances such as free bilirubin (hyperbilirubinemia), lipids (hyperlipidaemia) and bile acids. Bisalbuminemia in a patient with similar electrophoretic picture should suggest the search for underlying diseases.
